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PubMed2006

Pars plana vitrectomy for juxtapapillary capillary retinal angioma.

PURPOSE: To describe the treatment of juxtapapillary capillary angioma by pars plana vitrectomy (PPV) and tumor excision. DESIGN: Interventional case report. METHODS: A 6-year-old girl with symptomatic juxtapapillary capillary retinal angioma with associated epiretinal membrane (ERM) underwent PPV and extraction of the tumor and ERM. A clinical and molecular genetic workup for the presence of von Hippel-Lindau disease (VHL) was performed. RESULTS: A favorable functional result without tumor recurrence was achieved. Capillary retinal angioma was confirmed by histology of the surgical specimen, and familial VHL was revealed. CONCLUSIONS: PPV and extraction of the tumor is applicable in juxtapapillary capillary retinal angioma with associated ERM. A workup for the presence of VHL is pertinent in patients presenting with this tumor entity.

Child↗
PubMed2006

Autologous serum for the treatment of corneal epithelial abrasions in diabetic patients undergoing vitrectomy.

PURPOSE: To compare the effect of autologous serum versus hyaluronic acid for the treatment of epithelial corneal lesions in patients such as diabetics with reduced wound healing. DESIGN: Prospective, randomized, masked clinical trial. METHODS: Diabetic patients undergoing pars plana vitrectomy mostly combined with cataract extraction and intraocular lens (IOL) implantation who received corneal abrasion for better intraoperative visualization were included in this study. A standardized 8-mm diameter corneal abrasion was performed. Patients were randomized into one group treated with hourly application of autologous serum and another treated with hyaluronic acid drops (Vislube). Besides the time necessary for closure of the corneal epithelium other parameters such as patients' age, gender, duration of surgery, history of diabetes, and current HbA1C were evaluated. RESULTS: A total of 23 patients were enrolled (15 men, eight women); the autologous serum group consisted of 13 patients, the hyaluronic acid (Vislube) group consisted of 10 patients. Patients' mean age was 64.8 years; mean duration of diabetes was 19.4 years. On average, the operation lasted 145 minutes. Mean epithelialization time was 7.1 days in the hyaluronic acid group. In the autologous serum group, epithelium healed after a mean of 4.3 days. Mann-Whitney U test for statistical analysis showed a significant difference of epithelial closure time between both groups (P < .05); therefore, the study was stopped after treatment of 23 patients. CONCLUSIONS: It appears that autologous serum leads to a much faster closure of corneal epithelial wounds after abrasion compared with artificial tears.

Cataract Extraction↗
PubMed2006

Pars plana vitrectomy and perfluoropropane (C3F8) tamponade for retinal detachment due to myopic macular hole: a prognostic factor analysis.

PURPOSE: To determine the prognostic factors associated with anatomical success in the treatment of retinal detachment (RD) due to myopic macular hole by pars plana vitrectomy (PPV) and perfluoropropane (C3F8) gas tamponade. DESIGN: Retrospective, interventional, comparative case series. METHODS: In an institutional setting, 57 eyes with myopic macular hole RDs treated by PPV and C3F8 tamponade, with or without concomitant internal limiting membrane (ILM) peeling, endolaser photocoagulation, and/or phacoemulsification, were analyzed. Outcome measures were anatomical success, defined as closure of macular hole with reattachment of the surrounding retina, and postoperative best-corrected visual acuity (BCVA). RESULTS: The mean postoperative follow-up was 26.9 +/- 16.5 months. The anatomical success rate after primary PPV and C3F8 tamponade was 63.2%. Regression analysis showed that shorter axial lengths (odds ratio [OR] = 6.73, 95% confidence interval [95% CI] 1.86 to 12.22, P = .010), concomitant ILM peeling (OR 1.59, 95% CI 1.14 to 2.38, P = .013), and shorter duration of macular hole RD (OR 0.81, 95% CI 0.67 to 0.98, P = .033) were associated with a higher anatomical success. The mean pre- and postoperative BCVAs were 1.430 +/- 0.273 (range, 0.523 to 1.700) and 1.403 +/- 0.271 (range, 0.699 to 1.800) logarithm of minimal angle of resolution units, respectively. The postoperative BCVA was significantly better in eyes with macular hole closure than in eyes without (P = .021). CONCLUSIONS: Axial length, concomitant ILM peeling, and duration were important prognostic factors for PPV and C3F8 tamponade in the treatment of myopic macular hole RDs.

Adult↗
PubMed2004

Artisan lens implantation to correct aphakia after vitrectomy for retained nuclear lens fragments.

PURPOSE: To report the results of pars plana vitrectomy (PPV) for retained lens fragments with implantation of an Artisan intraocular lens (IOL) (Ophtec) to correct aphakia. SETTING: University-based referral center. METHODS: In this retrospective case-controlled study, patients who had had a PPV to remove dislocated lens fragments and implantation of an Artisan IOL for pseudophakic correction during initial cataract surgery or PPV were reviewed. RESULTS: Thirteen patients were identified. The preoperative visual acuity was better than 20/200 in 5 patients and the intraocular pressure (IOP) was higher than 21 mm Hg in 8 patients; 3 patients had normal corneas. In 4 patients, an Artisan IOL was implanted during cataract surgery. Postoperative complications included recurrent erosion (1 eye), premacular fibrosis (2 eyes), and a retinal tear (1 eye). Elevation of the IOP occurred in 2 patients and was controllable with medication. Pupillary block developed in 1 patient and persistent cystoid macular edema in another. All but 2 patients gained more than 2 lines of visual acuity postoperatively, and all corneas remained clear during the follow-up (mean 28.9 months; range 2.5 to 69.0 months). CONCLUSIONS: After the removal of dislocated lens fragments with a PPV, Artisan IOL implantation in aphakic patients without capsule support led to few complications and good visual acuity. Placement of an Artisan IOL requires fewer manipulations than transscleral suture fixation of a posterior chamber IOL.

Aged↗
PubMed2006

Combined phacoemulsification, foldable intraocular lens implantation, and 25-gauge transconjunctival sutureless vitrectomy.

We describe a technique for combined cataract and vitreoretinal surgery using a 25-gauge transconjunctival sutureless vitrectomy system. This technique was successfully performed in 20 consecutive cases. Outcomes were assessed in terms of visual acuity, intraocular pressure, postoperative refractive error, and incidence of complications. The technical feasibility, rationale, and advantages and disadvantages of this technique are discussed.

Adult↗
PubMed2006

Cystoid macular edema after pars plana vitrectomy for retained lens fragments.

PURPOSE: To describe the incidence and clinical course in patients with cystoid macular edema (CME) following pars plana vitrectomy (PPV) for retained lens fragments. SETTING: Retina group, private practice. METHODS: This retrospective study reviewed the medical records of 91 patients who had PPV for retained lens fragments. The patients were followed for at least 6 months. Patients with concomitant eye diseases that adversely affected macular examination or macular function were excluded. RESULTS: Four (8%) of 50 eyes with a sulcus-fixated posterior chamber intraocular lens (PC IOL) implanted at cataract extraction and 19 (46%) of 41 eyes with aphakia or an anterior chamber IOL developed CME (P</=.001, chi-square test). The CME developed a mean of 4 months after PPV. Treatment consisted of steroid eyedrops in all eyes; 17 eyes were also treated with a topical cyclooxygenase inhibitor, and 5 eyes received posterior sub-Tenon's steroid injections. The CME resolved a mean of 2 months after 1 treatment course in 12 eyes, which had a final visual acuity of 20/40 or better. The CME resolved, recurred, and then resolved in 6 eyes. In these eyes, the first incidence lasted a mean of 4 months. The second episode occurred a mean of 5 months after the initial episode resolved and took a mean of 3 months to resolve. Final visual acuity was 20/40 or better in 5 of these eyes. The CME persisted in 5 eyes that were followed for a mean of 30 months. None of these eyes had an acuity of 20/40 or better. CONCLUSIONS: Sulcus placement of a PC IOL at cataract extraction was associated with a reduced risk for CME. The prognosis for eyes that develop CME after PPV for retained lens fragments is guarded. Long-term therapy should be considered because of the high rate of recurrence.

Aged↗
PubMed2006

Clinical outcomes of combined sutureless vitrectomy with triamcinolone stain to manage vitreous loss resulting from posterior capsule rupture during phacoemulsification.

PURPOSE: To investigate the efficacy of sutureless pars plana vitrectomy (PPV) combined with intracameral triamcinolone stain in the management of vitreous loss associated with phacoemulsification. SETTING: Department of Ophthalmology, Tri-Service General Hospital, Taipei, Taiwan, Republic of China. METHODS: This retrospective review comprised the charts of 21 patients who had sutureless PPV combined with intracameral triamcinolone stain to manage vitreous loss resulting from posterior capsule rupture during phacoemulsification. The charts were analyzed for type of cataract, posterior segment pathology, methods of anesthesia, intraocular lens (IOL) placement, postoperative visual acuity, intraocular pressure, and complications. Additional outcome measurements were duration of the surgical procedures, period of postoperative corneal edema, and time to achieve stable vision. RESULTS: Excluding 2 eyes with preexisting conditions, 18 of 19 eyes (94.7%) had a final best corrected visual acuity (BCVA) of 20/40 or better and 42.1% (8/19) had a final BCVA of 20/20 or better. The mean duration of the surgery was 25.3 minutes (range 16 to 40 minutes). Corneal edema was noted in 12 eyes (57.1%) 3 days postoperatively and 3 eyes (14.3%) at 7 days. Eleven eyes (52.4%) had stable vision at 1 week, and 16 eyes (76.2%) had stable vision within 1 month postoperatively. Four eyes (19.0%) had postoperative complications that included a displaced IOL in 3 eyes (14.3%) and cystoid macular edema in 1 eye (4.8%). CONCLUSIONS: Self-sealing, sutureless PPV combined with intracameral triamcinolone stain was a safe, reliable adjunct to manage vitreous loss during phacoemulsification. The surgery led to rapid visual recovery.

Adult↗
PubMed2007

Factors influencing refractive outcomes after combined phacoemulsification and pars plana vitrectomy: results of a prospective study.

PURPOSE: To evaluate the factors influencing the refractive outcomes of combined phacoemulsification, foldable intraocular lens (IOL) implantation, and pars plana vitrectomy (PPV). SETTING: Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea. METHODS: One hundred fifty-four consecutive patients who had combined phacoemulsification, IOL implantation, and PPV between September 2001 and August 2004 were enrolled in a prospective study. Refractive, keratometric, and axial length measurements were performed preoperatively and 4 months postoperatively. The factors influencing the postoperative refractive outcomes were analyzed. RESULTS: The mean refractive prediction error (ie, actual minus predicted spherical equivalent [SE]) was -0.06 diopters (D) +/- 0.75 (SD). In long eyes (preoperative axial length more than 24.5 mm), the mean predicted SE and actual SE were -0.81 +/- 0.76 D and -1.24 +/- 0.79 D, respectively; the difference was significantly different (P = .001, paired t test). Patients with a preoperative visual acuity worse than 5/200 and those with preoperative foveal detachment had a significant postoperative myopic shift (P = 0.024 and P = 0.002, respectively; paired t test). Postoperative refractive error was not influenced by the intraocular air or gas tamponade during surgery (P = 0.336, paired t test). CONCLUSIONS: The combined surgery included a small biometric error that was within the tolerable range in most cases. However, myopic shifts developed in patients with long axial lengths, poor preoperative visual acuity, and the preoperative presence of foveal detachment.

Adult↗
PubMed2004

Droperidol and dolasetron alone or in combination for prevention of postoperative nausea and vomiting after vitrectomy.

PURPOSE: Droperidol and the new serotonin-3 antagonists are effective drugs for the prophylaxis of postoperative nausea and vomiting (PONV). The aim of this trial was to evaluate whether dolasetron could be a substitute for droperidol, because the Food and Drug Administration has required a Black Box warning on the droperidol package insert. DESIGN: Randomized, placebo-controlled, double-blinded trial. PARTICIPANTS: Inpatients undergoing vitreoretinal surgery (standard 3-port pars plana vitrectomy for proliferative diabetic vitreoretinopathy, complicated retinal detachment, or macular disease, such as macular pucker, macular hole, or choroidal neovascularization). INTERVENTION: Two hundred forty patients (3x80) receiving droperidol (10 microg. kg(-1)), dolasetron (12.5 mg), or the combination of both drugs administered 5 to 10 minutes before the end of surgery. CONTROL: Eighty patients received saline placebos as controls. METHODS: Standardized general anesthesia was performed, including benzodiazepine premedication, propofol, atracurium or vecuronium, desflurane in N(2)O/O(2), and a continuous infusion of remifentanil. Postoperative analgesia and antiemetic rescue medication were standardized. Episodes of vomiting, retching, nausea, and the need for additional antiemetics were recorded for 24 hours. MAIN OUTCOME MEASURES: Severity of PONV (rated by a standardized scoring algorithm) was analyzed as the main end point of the study using the Kruskal-Wallis test. RESULTS: Data of 304 patients could be analyzed. Mean severity scores in the placebo, dolasetron, droperidol, and combination groups were 1.21, 0.76, 0.47, and 0.30. Incidences of PONV of any severity were 56%, 40%, 28%, and 18%, respectively. The reduction of the incidence of PONV and its severity was statistically significant in the droperidol group and in the combination group relative to the placebo. Dolasetron alone failed to reduce the incidence of PONV. The combination of dolasetron and droperidol showed an additive antiemetic efficacy. CONCLUSION: Low-dose droperidol (10 microg. kg(-1)) but not dolasetron (12.5 mg) reduced postoperative nausea and vomiting after vitreoretinal surgery. Dolasetron (12.5 mg) is not an equivalent substitute for droperidol.

Aged↗
PubMed2004

Long-term follow-up of indocyanine green-assisted peeling of the retinal internal limiting membrane during vitrectomy surgery for idiopathic macular hole repair.

OBJECTIVE: To determine the long-term efficacy of indocyanine green (ICG)-assisted retinal internal limiting membrane (ILM) peeling during macular hole repair. DESIGN: Retrospective, interventional, noncomparative case series. PARTICIPANTS: One hundred twenty-one eyes of 114 patients with stage 2, 3, or 4 idiopathic macular holes that underwent ICG-assisted macular hole repair during the period of August 1999 to January 2003. INTERVENTION: All eyes underwent a pars plana vitrectomy, including peeling of the posterior cortical hyaloid when necessary. Indocyanine green dye (0.5%) was instilled over the macula, and after removal of the ICG, the retinal ILM was peeled. Medium- to long-acting gas tamponade was used in all cases, and all patients were asked to position themselves facedown for 1 to 2 weeks. MAIN OUTCOME MEASURES: Long-term postoperative anatomic results, visual acuity (VA), and complications. RESULTS: Patients were observed postoperatively for an average of 26 months (range, 12-53). Anatomic closure of the macular hole was achieved in 118 eyes (98%) with a single surgery. Reoperation was successful at closing 2 of the 3 macular holes that did not close initially. One macular hole reopened 16 months after the original surgery, and the patient has not yet undergone further surgery. Visual acuity improved by > or =2 lines in 116 eyes (96%). Mean visual improvement after surgery was 6 lines (range, 0-14), and 96 eyes (79%) achieved a final VA of 20/50 or better. There were no intraoperative or postoperative complications attributed to the use of ICG. CONCLUSIONS: Long-term follow-up of patients who underwent ICG-assisted ILM peeling for idiopathic macular hole repair demonstrates excellent anatomic and visual results.

Aged↗
PubMed2004

Visual outcomes after lens-sparing vitrectomy for stage 4A retinopathy of prematurity.

PURPOSE: To assess the visual outcomes of patients with stage 4A retinal detachments (RDs) from retinopathy of prematurity (ROP). DESIGN: Retrospective review of a consecutive case series of children referred to the pediatric retina service of Associated Retinal Consultants, Royal Oak, Michigan. PARTICIPANTS: Forty-five eyes of 39 children. METHODS: The stage of RD for each patient was determined during an examination under anesthesia. All patients underwent a lens-sparing pars plana vitrectomy (PPV) with membrane peeling. Postoperative anatomic status was determined by ophthalmoscopy either during an office examination or during an examination under anesthesia. Visual outcomes were ascertained by consulting pediatric ophthalmologists using either Teller or Allen acuities. MAIN OUTCOME MEASURES: Anatomic and visual outcomes. RESULTS: Formalized visual acuity (VA) measurement was performed in 23 eyes of 20 children, and was not performed in 22 eyes of 19 children. All 23 eyes that were formally tested had successful retinal reattachment. The macula appeared to be normal and without distortion in 19 of 23 eyes (83%) during the follow-up period. Average logarithm of the minimum angle of resolution VA was 20/58. Three eyes had acuities of 20/200, and 4 had acuities of 20/100. All other eyes were 20/80 or better. Average age at time of VA was 3.51 years. CONCLUSIONS: Patients with ROP and stage 4A RDs can be treated successfully with respect to anatomic and visual outcome utilizing lens-sparing PPV.

Gestational Age↗
PubMed2005

Pars plana vitrectomy alone for the management of inferior breaks in pseudophakic retinal detachment without facedown position.

OBJECTIVE: To introduce a new approach with pars plana vitrectomy (PPV) alone and no facedown positioning in the management of pseudophakic retinal detachments (RDs) with inferior breaks. DESIGN: Prospective noncomparative interventional case series. PARTICIPANTS: Forty consecutive pseudophakic eyes of 40 patients with rhegmatogenous RD with causative inferior breaks. INTERVENTION OR METHODS: All eyes underwent PPV alone, with air as tamponade and with no facedown position in the postoperative period. The supine position was used in some cases for 30 minutes. MAIN OUTCOME MEASURES: Postoperative primary and final anatomical outcome, visual acuity (VA), and complications. RESULTS: Patients were observed for a minimum of 7 months (mean, 11.7). Primary retinal reattachment was obtained in 36 of 40 patients (90%). Final reattachment was obtained in 40 of 40 patients (100%). One patient (2.5%) developed proliferative vitreoretinopathy at the sixth week after surgery. Three patients (7.5%) redetached, presumably due to untreated breaks. Two patients (5%) developed a macular epiretinal membrane that required surgery. Mean preoperative best-corrected VA (BCVA) was 20/63 (range, hand movements [HM] to 20/20). Mean final BCVA was 20/33 (range, 20/200-20/20). Of the 16 eyes with a macula-attached rhegmatogenous RD, mean preoperative BCVA was 20/29 (range, 20/100-20/20). Mean postoperative BCVA was 20/30 (range, 20/60-20/20). Of the 24 eyes with macula-detached RDs, mean preoperative BCVA was 20/300 (range, HM to 20/40). Mean postoperative BCVA was 20/36 (range, 20/200-20/20). Visual acuity of 20/40 or better was seen in 17 of 24 eyes (70.8%). CONCLUSIONS: This pilot study provides evidence that the facedown posture after PPV is not necessary to achieve retinal reattachment in pseudophakic RD with inferior breaks.

Adult↗
PubMed2005

Management and outcomes of postoperative endophthalmitis since the endophthalmitis vitrectomy study: the Endophthalmitis Population Study of Western Australia (EPSWA)'s fifth report.

PURPOSE: To examine if changes in the diagnosis and management of postoperative endophthalmitis have occurred since 1995, and to identify factors that might predict final visual outcome. DESIGN: Retrospective, population-based, noncomparative, consecutive case series. PARTICIPANTS: Patients with clinically diagnosed endophthalmitis after cataract surgery and lens-related surgery in Western Australia from 1980 to 2000. METHODS: Endophthalmitis cases were identified using record linkage and cross-referencing with the surgical logbooks of vitreoretinal surgeons before validation by medical record review. MAIN OUTCOME MEASURES: Microbiological data (microorganisms isolated and antibiotic susceptibilities), diagnostic interventions, surgical procedures, therapeutic interventions, and visual acuity (VA). RESULTS: During the 21-year period, 213 episodes of endophthalmitis occurred after cataract surgery. Since 1995, both anterior chamber sampling and vitreous sampling have increased significantly. The overall use of vitrectomy has also increased, but we did not observe a difference according to presenting VA. Intravitreal antibiotic use increased significantly, whereas the use of both subconjunctival and IV antibiotics decreased. In one third of patients, the VA at least 6 months after admission for endophthalmitis was worse than 6/18. This was associated with treatment that did not include the use of oral antibiotics (odds ratio [OR], 3.86; 95% confidence interval [CI], 1.21-12.39; P = 0.02), growth from intraocular samples of organisms other than coagulase-negative staphylococci (OR, 9.84; 95% CI, 2.84-34.09; P<0.001), and a discharge VA worse than 6/18 (OR, 6.10; 95% CI, 1.63-22.89; P = 0.01). CONCLUSIONS: Although we observed noticeable changes in the diagnosis and management of endophthalmitis since 1995, visual outcomes have not improved and remain poor. Our finding that treatment with oral antibiotics may be associated with a better visual outcome warrants further investigation.

Aged↗
PubMed2005

Anatomic success rate after 3-port lens-sparing vitrectomy in stage 4A or 4B retinopathy of prematurity.

PURPOSE: To assess the anatomic success rate after 3-port lens-sparing vitrectomy (LSV) in stage 4A and 4B tractional retinal detachments (TRDs) due to retinopathy of prematurity (ROP). DESIGN: A chart review and data evaluation of 108 eyes of 102 consecutive patients presenting with stage 4A (32 eyes) or 4B (76 eyes) TRDs that underwent primary LSV from February 1998 to January 2004 were performed. INTERVENTION: Three-port LSV was performed on all eyes by the same surgeon (ERH). MAIN OUTCOME MEASURES: Retinal reattachment status was reviewed at final follow-up visit, which ranged from 6 to 48 months (mean, 32 months) after LSV. RESULTS: Ninety-two of 108 (85.2%) eyes were reattached after a single LSV and 102 of 108 (94.4%) eyes ultimately achieved at least partial posterior pole reattachment at the final follow-up visit. All 4A eyes achieved complete reattachment and 70 of 76 (92.1%) 4B eyes achieved partial or complete reattachment. Reversal or complete arrest of dragging of the macula was noted in all eyes that maintained partial or complete reattachment (94.4%). Six (5.6%) 4B eyes remained detached despite additional vitreoretinal procedures; 4 (66.7%) of these had intraoperative retinal tears. CONCLUSIONS: Eighty-five percent of eyes with 4A and 4B TRDs secondary to ROP were completely reattached with a single 3-port LSV procedure and nearly 95% were ultimately at least partially reattached at the posterior pole by the final follow-up visit. The development of retinal tears intraoperatively portended a poor prognosis for reattachment.

Disease Progression↗
PubMed2006

Optical coherence tomography analysis of the macula after vitrectomy surgery for retinal detachment.

OBJECTIVE: To define the incidence, duration, and clinical associations of persistent localized submacular fluid after pars plana vitrectomy (PPV) retinal detachment surgery. DESIGN: Observational cohort series. PARTICIPANTS: One hundred patients were identified and recruited into the study. METHODS: Patients aged 18 years and older who had undergone PPV and gas as a primary procedure for rhegmatogenous retinal detachment and postoperative follow-up were recruited from February through August 2004. All patients underwent clinical examination, optical coherence tomography (OCT) scan of the macula, and retinal thickness analysis scan of the macula. Those patients in whom an abnormality was seen on OCT at 6 weeks after surgery underwent follow-up with repeat of the study investigations at 3, 6, 9, 12, and 18 months after surgery until the abnormality resolved. If no abnormality was seen at the 6-week examination, no further investigation was undertaken. Demographic data, including detachment characteristics, were collected retrospectively from the patient case notes. MAIN OUTCOME MEASURES: The principle outcome measure was the presence of subretinal fluid (SRF) on OCT at 6 weeks after surgery. Other outcome measures included duration of persistent fluid and association with visual outcome and type and duration of detachment. RESULTS: One hundred patients were recruited; 15 of these had SRF on OCT performed at 6 weeks after surgery. Subretinal fluid was associated with significantly worse visual acuity (VA) at 6 weeks (P = 0.033, Wilcoxon rank-sum); those with SRF had a median VA of 0.4, and those with no SRF had a median VA of 0.3. The fluid took a median of 5.5 months to resolve. Seven patients had combined PPV and scleral buckle surgery; none of these had fluid at 6 weeks. CONCLUSIONS: Optical coherence tomography is a useful noninvasive diagnostic method that can detect SRF not appreciated on clinical examination. Persistent SRF after PPV and gas surgery occurred in 15% of patients in this study and was still present in 53% of these at 6 months. The presence of SRF at 6 weeks after surgery was associated with a poorer visual outcome at this time point.

Adult↗
PubMed2000

Spontaneous luxation of encapsulated intraocular lens onto the retina after a triple procedure of vitrectomy, phacoemulsification, and intraocular lens implantation.

PURPOSE: To report the clinical and histological findings of a luxated intraocular lens (IOL) in the capsular bag. METHODS: Review of a case. RESULTS: Twenty-three months after a triple procedure of vitrectomy, phacoemulsification, and IOL implantation for diabetic vitreous hemorrhage and cataract, the encapsulated IOL spontaneously luxated. Scanning electron microscopy showed sparsely distributed anterior and equatorial zonules, with only a few posterior zonules on the surface of the removed capusular bag. CONCLUSION: The absence of the anterior hyaloid membrane and posterior zonules and contraction of the lens capsule may cause dialysis of the zonules. Therefore, the anterior hyaloid membrane should be left in place in patients at low risk for the development of postoperative proliferation to maintain the long-term stability of the IOL.

Aged↗
PubMed2001

Pars plana vitrectomy, subretinal injection of tissue plasminogen activator, and fluid-gas exchange for displacement of thick submacular hemorrhage in age-related macular degeneration.

PURPOSE: To evaluate a new procedure for displacement of large, thick submacular hemorrhage in patients with age-related macular degeneration. METHODS: Retrospective review of 11 eyes of 11 patients with age-related macular degeneration and thick submacular hemorrhage (defined as causing retinal elevation detectable on stereo fundus photographs) treated with vitrectomy, subretinal injection of tissue plasminogen activator (25 or 50 microg), and fluid-gas exchange with postoperative prone positioning. Outcome measures included displacement of hemorrhage from the fovea, best postoperative visual acuity, and final postoperative visual acuity. RESULTS: In the 11 affected eyes of 11 patients (seven men and four women; mean age, 76 years), preoperative visual acuity ranged from 20/200 to hand motions. With surgery, subretinal hemorrhage was displaced from the fovea in all 11 cases. Mean postoperative follow-up was 6.5 months (range, 1 to 15 months). Best postoperative visual acuity varied from 20/30 to 5/200, with improvement in nine (82%) cases and no change in two cases. Eight eyes (73%) measured 20/200 or better, with four of these eyes (36%) 20/80 or better. Final postoperative visual acuity ranged from 20/70 to light perception, with improvement in eight (73%) cases, no change in one case, and worsening in two cases. A statistically significant difference was found between preoperative and best postoperative visual acuity (P =.004) but not between preoperative and final visual acuity (P =.16). Hemorrhage recurred in three (27%) eyes, causing severe visual loss in one eye. CONCLUSIONS: This technique displaces submacular hemorrhage from the fovea and can improve vision in patients with age-related macular degeneration. However, recurrence of hemorrhage occurred in 27% of eyes and caused severe visual loss in one eye. A randomized, prospective clinical trial is necessary to determine the efficacy of this technique in comparison with other proposed treatments.

Aged↗